Wiener klinische Wochenschrift

, Volume 124, Issue 15–16, pp 538–551 | Cite as

Therapie des kastrationsrefraktären Prostatakarzinoms

  • Michael Rauchenwald
  • Michael Krainer
  • Thomas Bauernhofer
  • Maria De Santis
  • Wolfgang Höltl
  • Gero Kramer
  • Steffen Krause
  • Wolfgang Loidl
  • Renée Oismüller
  • Andreas Reissigl
  • Nikolaus Schmeller
  • Walter Stackl
  • Franz Stoiber
  • Thorsten Füreder
konsensus bericht
  • 230 Downloads

Zusammenfassung

Innerhalb der letzten zwei Jahre hat die Therapie des kastrationsrefraktären Prostatakarzinoms (CRPC) große Fortschritte gemacht. Sowohl die COU-AA-301 Phase-III-Studie als auch die TROPIC Studie zeigten einen Überlebensvorteil für Patienten nach Docetaxel-Versagen, die mit Abirateron beziehungsweise Cabazitaxel behandelt wurden. In einem Umfeld von wachsendem Interesse an chemotherapeutischen Optionen und neuen Medikamenten war es unser Ziel, als multidisziplinäres Team die verfügbare Datenlage zu analysieren und einen Standard für die medizinische Behandlung des Prostatakarzinoms außerhalb klinischer Studien zu definieren. Vor diesem Hintergrund evaluieren wir die momentanen Behandlungsempfehlungen sorgfältig und auf Basis der verfügbaren Anhaltspunkte, beleuchten mögliche zukünftige Behandlungsoptionen und diskutieren wichtige klinische Themen wie die Behandlung bis zur Progression versus den Vorteilen von Chemoholidays und die Definition bestimmter Patientensubgruppen. Zusätzlich legen wir besonderes Augenmerk auf neue molekulare Wirkstoffklassen, deren Verfügbarkeit in naher Zukunft erwartet wird, wie z. B. MDV3100 und Sipuleucel T. Die Rolle und Bedeutung der Palliation mittels Strahlentherapie und der proaktiven medikamentösen analgetischen Therapie wird ebenso diskutiert wie neue Therapieoptionen der mit Knochenmetastasen assoziierten Beschwerden. Die Vielzahl an Behandlungsoptionen für Patienten mit fortgeschrittenem Prostatakarzinom verlangt eindeutig eine enge Zusammenarbeit zwischen Urologen, Onkologen und Strahlentherapeuten.

Summary

Within the last two years the therapy of castration resistant prostate cancer (CRPC) has made major advances. Both the COU-AA-301 phase III trial and the TROPIC trial showed a survival benefit for patients after docetaxel failure treated with abiraterone or cabazitaxel, respectively. With rising interest for chemotherapeutic options and novel drugs, our goal was to review within the context of a multidisciplinary team the available evidence and explore the standards for medical treatment of prostate cancer outside of clinical trials. From this background, we are carefully evaluating the current treatment recommendations, based on the available evidence, and highlight potential future treatment options but also discuss important clinical topics like treatment until progression versus the advantage of chemo holidays and definition of particular patient subgroups. Additionally, we focus on novel molecular entities, which will most likely be available in the near future, such as MDV3100 and Sipuleucel T. The role and importance of palliation with radiotherapy and proactive medical management of pain is also discussed, as well as new options for bone directed therapy. The multitude of treatment options for patients with advanced prostate cancer clearly asks for a close collaboration between urologists, medical oncologists and radiation therapists.

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Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  • Michael Rauchenwald
    • 1
  • Michael Krainer
    • 2
  • Thomas Bauernhofer
    • 3
  • Maria De Santis
    • 4
  • Wolfgang Höltl
    • 5
  • Gero Kramer
    • 6
  • Steffen Krause
    • 7
  • Wolfgang Loidl
    • 8
  • Renée Oismüller
    • 9
  • Andreas Reissigl
    • 10
  • Nikolaus Schmeller
    • 11
  • Walter Stackl
    • 12
  • Franz Stoiber
    • 13
  • Thorsten Füreder
    • 2
  1. 1.Urologische Abteilung, DonauspitalWienÖsterreich
  2. 2.Klinische Abteilung für OnkologieUniversitätsklinik für Innere Medizin, Medizinische Universität WienWienÖsterreich
  3. 3.Department für Hämato-Onkologie, LKH Leoben-EisenerzLeobenÖsterreich
  4. 4.3. Medizinische Abteilung, KFJ-SpitalWienÖsterreich
  5. 5.Urologische Abteilung, KFJ-SpitalWienÖsterreich
  6. 6.Universitätsklinik für Urologie, Medizinische Universität WienWienÖsterreich
  7. 7.Urologische AbteilungAKH LinzÖsterreich
  8. 8.Urologische Abteilung, KH d. Barmh. SchwesternLinzÖsterreich
  9. 9.Institut für Radioonkologie, DonauspitalWienÖsterreich
  10. 10.Urologische AbteilungLKH BregenzÖsterreich
  11. 11.Urologische Abteilung, KH d. Barmh. BrüderSalzburgÖsterreich
  12. 12.Urologische Abteilung, KH RudolfstiftungWienÖsterreich
  13. 13.Urologische Abteilung, LKH VöcklabruckVöcklabruckÖsterreich

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